Provider Demographics
NPI:1336419456
Name:CHO, GRACE SUN AH (OD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SUN AH
Last Name:CHO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3491 IRON BARK WAY
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6223
Mailing Address - Country:US
Mailing Address - Phone:714-262-3063
Mailing Address - Fax:562-902-4984
Practice Address - Street 1:11900 SOUTH ST
Practice Address - Street 2:SUITE 121
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6847
Practice Address - Country:US
Practice Address - Phone:562-809-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12556T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist